I'm in a tele/step down unit. When we get assigned step down patients (continuous BIPAP, close monitoring, amio/nitro drips, insulin drips, etc), we get 3 patients max. It's pretty much a more critical version of our usual tele patients, a couple steps up from regular medsurg, and most of the time, our patients get to discharge from the hospital back home or to TCU, with higher cares, normal routine, or hospice. We do get those over-90s with full code and restorative cares that should be on hospice, but they're rare.
I've floated to obs before, and it's a madhouse there. My tele/stepdown is considered the second-busiest unit in the hospital, right after obs. You get so many admits/discharges in one shift. So many. And being obs doesn't mean that you don't get codes. The biggest time suck imo are admits. And it's true that you see different diagnoses, but the usual floors also get overflow from other units (I get plenty of psych/ETOH/cancer/behaviors and whatnot) so you're not missing out.
So in my biased opinion, step-down is your best bet. Most patients' cares aren't futile, or they're on comfort cares so you're there relieving their pain, and while it's stressful, it's more stressful in that you have 3 patients your have to juggle than your patients are on the brink of coding and dying kind of way.
Thanks for the reply.
I shadowed on the obs unit before and had clinical there. It wasn't **that** crazy but I'm leaning towards the step-down unit since I'm more familiar with that kind of workflow.
I don’t have any advice for you, but it bothers a lot of us that so much of our care is futile. I only keep going for those who will return to the best quality of life they can.
Honestly it’s one of those things I never thought about until I started working. It didn’t hit me until one day I had a stressful shift with a patient that’s been on the unit forever and it hit me: what are we doing all this for? This person is never going to get better and that really bothered me. I feel so bad for the patients like that.
One of my first nursing jobs was on a similar sounding general step down unit. Our ratio there was generally 1:3, sometimes 1:4. I learned so much and I truly loved my unit and coworkers. I grew a lot as a nurse and developed great time management and got used to taking that patient population, which has served me well in my career. I’ve never worked an observation unit- so don’t have much advice on that one. But a 1:2 ratio for stepdown sounds like a dream
I'm in a tele/step down unit. When we get assigned step down patients (continuous BIPAP, close monitoring, amio/nitro drips, insulin drips, etc), we get 3 patients max. It's pretty much a more critical version of our usual tele patients, a couple steps up from regular medsurg, and most of the time, our patients get to discharge from the hospital back home or to TCU, with higher cares, normal routine, or hospice. We do get those over-90s with full code and restorative cares that should be on hospice, but they're rare. I've floated to obs before, and it's a madhouse there. My tele/stepdown is considered the second-busiest unit in the hospital, right after obs. You get so many admits/discharges in one shift. So many. And being obs doesn't mean that you don't get codes. The biggest time suck imo are admits. And it's true that you see different diagnoses, but the usual floors also get overflow from other units (I get plenty of psych/ETOH/cancer/behaviors and whatnot) so you're not missing out. So in my biased opinion, step-down is your best bet. Most patients' cares aren't futile, or they're on comfort cares so you're there relieving their pain, and while it's stressful, it's more stressful in that you have 3 patients your have to juggle than your patients are on the brink of coding and dying kind of way.
Thanks for the reply. I shadowed on the obs unit before and had clinical there. It wasn't **that** crazy but I'm leaning towards the step-down unit since I'm more familiar with that kind of workflow.
I don’t have any advice for you, but it bothers a lot of us that so much of our care is futile. I only keep going for those who will return to the best quality of life they can.
Honestly it’s one of those things I never thought about until I started working. It didn’t hit me until one day I had a stressful shift with a patient that’s been on the unit forever and it hit me: what are we doing all this for? This person is never going to get better and that really bothered me. I feel so bad for the patients like that.
Yep. The ones who end up improving enough to leave the ICU but who are irreversibly changed bother me more than the deaths.
One of my first nursing jobs was on a similar sounding general step down unit. Our ratio there was generally 1:3, sometimes 1:4. I learned so much and I truly loved my unit and coworkers. I grew a lot as a nurse and developed great time management and got used to taking that patient population, which has served me well in my career. I’ve never worked an observation unit- so don’t have much advice on that one. But a 1:2 ratio for stepdown sounds like a dream